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Annual Report
Human Resources for Health in 2030/Philippines October 1, 2017 – September 30, 2018
Version for Distribution
Cooperative Agreement No. AID-OAA-A-15-00046
Cover photo: In a joint mission, USAID HRH2030/Philippines and World Health Organization (WHO)
experts engaged Cavite Governor (rightmost) in a discussion about human resources for health and the
delegation of mandates between the Department of Health and local governments. (Photo by: HRH2030)
This publication was produced for review by the United States Agency for International Development. It was
prepared by members of the HRH2030 consortium.
Table of Contents Table of Contents ............................................................................................................... i
Acronyms ........................................................................................................................... ii
1. Activity Overview/Executive Summary ................................................................... 1
1.1 Activity Information .......................................................................................................................... 1
1.2 Program Description/Introduction ............................................................................................... 1
2. Key Achievements ..................................................................................................... 3
Objective 1: Improve the effective skills mix, competency, and distribution of the
health workforce at the primary care level .................................................................... 3
Objective 2: Strengthen human resource for health leadership, governance, and
performance management ............................................................................................... 4
Objective 3: Improve the use of data for health workforce decision-making at
central and regional levels ................................................................................................ 6
Cross-Cutting 1: Organizational Development for the DOH (HHRDB, FHO, NTP) 8
Cross-Cutting 2: HRH Policy Environment Strengthened .......................................... 11
Key Challenges ................................................................................................................ 12
Project Management ...................................................................................................... 13
Communications ............................................................................................................. 14
3. Performance Status Per Key Indicator .................................................................. 14
3.1 Key Challenges and How They Are Being Addressed ........................................................... 16
4. Cross-Cutting Issues ................................................................................................ 21
4.1 Update on Gender .......................................................................................................................... 21
4.2 Update on Sustainability and Self-Reliance ................................................................................ 21
4.3 Update on Environmental Compliance and Climate Risk Mitigation .................................. 21
4.4 Update on Family Planning Compliance ..................................................................................... 21
5. Collaboration, Learning and Adapting .................................................................. 22
6. High-Level Planned Activities for Next Quarter, Including Upcoming Events . 23
7. Annexes .................................................................................................................... 25
7.1 Success Stories, Pictures, etc. ...................................................................................................... 25
Acronyms
AIHA American International Health Alliance
BA Baseline Assessment
BLHD Bureau of Local Health Development
CHED Commission on Higher Education
CLA
CMSS
Collaboration, Learning and Adaptation
coaching, mentoring, and supportive supervision
CPD
CSC
continuing professional development
Civil Service Commission
DOC Documentation Outreach and Communications
DOH Department of Health
FHO Family Health Office
FP
FPP
Global Fund
family planning
Family Planning Program
Global Fund to Fight AIDS, Tuberculosis and Malaria
HAF Human Resource Information System Assessment Framework
HHRDB Health Human Resource Development Bureau
HLMA
HRH
HRH2030
health labor market analysis
human resources for health
Human Resources for Health in 2030
HRIS
HRMD
HPDPB
human resource information system
Human Resource Management and Development
Health Policy Development and Planning Bureau
IRR Implementing Rules and Regulations
IST in-service training
KII key informant interview
LDI Learning and Development Intervention
LGU
MCH
local government unit
maternal and child health
MELA Monitoring, Evaluation, Learning, and Adaptation
NHWA
NTP
OD
National Health Worker’s Account
National Tuberculosis Control Program
organizational development
OWWA Overseas Worker Welfare Administration
PAD Personnel Administration Division
PhilSTEP Philippine Strategic TB Elimination Plan
PRC Professional Regulatory Commission
PX patient experience
RSA
SDN
return service agreement
Service Delivery Network
SOW scope of work
STTA short-term technical assistance
SWOT strengths, weaknesses, opportunities, and threats
TB
UHC
USAID
tuberculosis
Universal Health Care
United States Agency for International Development
USG U.S. government
WHO World Health Organization
WISN
WMHD
Workload Indicators of Staffing Need
Women and Men’s Health Division
HRH2030/Philippines Y1 Annual Report/1
1. Activity Overview/Executive Summary
1.1 Activity Information
Activity Name: Human Resources for Health in 2030 in the
Philippines (HRH2030/Philippines)
Activity Start Date and End Date: October 1, 2017 – August 30, 2020
Implementing Partner: Chemonics International
Contract/Agreement Number: AID-OAA-A-15-00046
Name of Subcontractors/Sub-
awardees:
Palladium, American International Health Alliance
(AIHA)
Geographic Coverage: National, regional, and selected provinces
Reporting Period: October1, 2017 to September 30, 2018
1.2 Program Description/Introduction
Human Resources for Health in 2030 in the Philippines (HRH2030/Philippines) is part of a global
initiative that helps low- and middle-income countries develop the health workforce needed to prevent
maternal and child deaths, support the goals of Family Planning 2020, control the HIV/AIDS epidemic,
and protect communities from infectious diseases.
HRH2030 contributes to the United States Agency for International Development’s (USAID) goal of
“Family Health Improved” by strengthening the health workforce for improved family planning (FP) and
tuberculosis (TB) outcomes and contributing to the Department of Health’s (DOH) goal of “Adequate
number of health human resources at all levels with competence to deliver universal health coverage
through the continuum of preventive, promotive, curative, and rehabilitative health interventions.”
HRH2030/Philippines works with the DOH and other key stakeholders to assess and strengthen human
resources for health (HRH) in support of FP, maternal and child health (MCH), and TB. Specifically,
HRH2030/Philippines provides capacity building to the DOH to strengthen the development,
deployment, training, and management of a fit-for-purpose and fit-for-practice health workforce in both
government and private sectors to improve equity, access, and quality of FP, MCH, and TB services.
Over the life of the activity, HRH2030/Philippines aims to achieve the following three objectives:
• Improve the effective skills mix, competency, and distribution of the health workforce at the
primary care level.
• Strengthen HRH leadership, governance, and performance management.
• Improve the use of data for health workforce decision-making at central and regional levels.
1.3 Description of Key Achievements for Year
HRH2030/Philippines is pleased to report that during the first six months, we completed mobilization of
our staff and became fully operational. The project was formally launched in May 2018, with participation
of more than 150 stakeholders from the HRH Network, a loose organization comprising public and
private agencies and organizations with government and professional mandates, and which works toward
the effective and efficient management of the health workforce in the Philippines. The Year 1 work plan
was officially approved on April 27, 2018. Activities for Year 1 primarily focused on obtaining buy in
from partners to conduct various assessments, scoping activities, and consultations on technical concept
notes and the development of assessment tools and methodologies. During Year 1, we completed most
of the scoping activities, but the assessments to design and launch interventions need more time and will
continue into Year 2. Highlights of accomplishments are:
• For Objective 1, HRH2030/Philippines developed evaluation questions for the assessment of
the DOH deployment program and a methodology for competency mapping called Competency
HRH2030/Philippines Y1 Annual Report/2
Assessment Tool for Physicians, Nurses, Medical Technologists, and Midwives for the Effective
Provision of Tuberculosis and Family Planning Services. HRH2030 also refined and developed
concept notes to conduct the health labor market analysis (HLMA), with guidance from the
World Health Organization (WHO). To expedite key interventions, we held discussions with
WHO on the sourcing of technical experts who will provide technical oversight and cutting-
edge tools, concepts, design, development, and rollout of the Workload Indicators of Staffing
Need (WISN) and the HLMA.
• For Objective 2, HRH2030 gathered information on the status of technology-assisted in-
service training (IST), or e-learning, and continuing professional development (CPD); compiled
the strengths, weakness, and opportunities in the DOH health workforce training; and measured
stakeholders’ readiness to fully participate in e-learning. The activity revealed that the e-learning
system procured by the DOH was not efficiently used due to the limited availability of learning
modules and a perceived lack of motivation, incentive, or promotion to access the system.
HRH2030 collaborated with the DOH to identify approaches to enhance the DOH Academy.
HRH2030 also conducted scoping activities on coaching, mentoring, and supportive supervision
(CMSS) to identify CMSS issues and needs, including expanding the coverage and quality of post-
training follow-up, having better organized CMSS teams, using DOH-recommended instruments,
and conducting more regular CMSS activities at DOH regional offices and at municipal levels.
• For Objective 3, the human resource information system (HRIS) assessment tool was
completed and administered to approximately 20 information systems currently managed in the
HRH Network and the DOH. Using the HRIS Assessment Framework (HAF), HRH2030 rapidly
assessed the capacity, functionality, and interoperability of the HRIS, and the HRH data
standards, data sharing guidelines, and HRIS governance mechanisms. The resulting priorities are
to define the HRH data standards to facilitate data sharing between and across the HRIS, and to
identify the official custodian who will use and analyze the HRH data collected by the DOH.
HRH2030/Philippines also mapped the current process for training in information system
management at the Health Human Resource Development Bureau (HHRDB), the National TB
Control Program (NTP), the FP Program (FPP) in the Women and Men’s Health Division
(WMHD), and at other selected DOH subnational levels focused on TB and FP/MCH. In a joint
mission with the WHO, HRH2030/Philippines engaged with and oriented key stakeholders on
the National Health Worker’s Account (NHWA) and supported the DOH in the design of the
initial draft of the NHWA implementation roadmap.
• For Organizational Development, HRH2030/Philippines developed a seven-point
organizational assessment approach for the HHRDB, supported the approach for the HHRDB
baseline assessment, and developed a job responsibilities questionnaire and interview instrument
for DOH leaders and executives. The project also developed a modified value chain analysis tool
for the HHRDB to use to identify capacity challenges in fulfilling its core mandate. The activity
helped conduct the HHRDB’s values-mission-vision workshop as a starting point to define some
of the components of HRH2030’s proposed Human Resource Management and Development
(HRMD) Framework. HRH2030 has offered this framework for the HHRDB’s consideration to
adopt and implement.
• For Policy, the activity created a policy inventory database and adapted tools for stakeholder
analysis, the assessment of information use by the HRH Network, and for policy
implementation. To implement the policy scoping assessment, HRH2030/Philippines started to
collect information on past and current policies affecting HRH planning, management, and
development at different levels, including national scope (Republic Acts) and sectoral scope
(administrative orders or memorandum orders). HRH2030 conducted several activities,
including outlining the objectives of the scoping assessment, methods for data collection and
analysis, key informants to be interviewed, and data collection tools to be used that will lead to
policy scoping results.
HRH2030/Philippines Y1 Annual Report/3
• For Coordination and Collaboration, and as discussed above under Objectives 1 and 3,
HRH2030 conducted a joint mission with the WHO, September 17 to 21, 2018, to provide
technical assistance to the DOH through the HHRDB in implementing the NHWA and WISN in
the Philippines. As a result of this joint mission, a roadmap detailing the framework and activities
to implement the NHWA and WISN were prepared by members of the HRN Network and
were presented to DOH by the team.
2. Key Achievements
In Year 1, HRH2030/Philippines aimed to advocate for and build national stakeholder involvement in the
human resource (HR) development goals and objectives of the DOH; conduct workforce-related
assessments, apply tools, and help partners; understand the current capacity of the HHRDB to manage,
deploy, and train its health workforce; identify efficiency gains in and across HR functions; and lay the
foundation for long-term sustainability of HRH management and development interventions, especially
those focused on contributing to the decrease of the TB burden and the increase in FP use.
Objective 1: Improve the effective skills mix, competency, and distribution of the health
workforce at the primary care level
Year 1 activities focused on four key interventions, namely: competency mapping, DOH deployment
program evaluation, HLMA, and WISN
Competency Mapping
Competency assessment tools with a focus on the four cadres (physicians, nurses, midwives, and
medical technologists) working in FP and TB were completed. The tools will be used for self-evaluation
and assessment of the cadres’ performance by their immediate superiors. Disparities in performance will
be used to prescribe training for these health workers. HRH2030 proposed a methodology for
competency mapping after reviewing all available competency-related materials gathered from the DOH
and key stakeholders representing the four cadres involved in TB and FP services.
Early in Year 1, it was discovered that there were professional initiatives in developing competency
standards and rubrics. They include the Integrated Midwives Association of the Philippines and the
Board of Nursing, which have developed competency rubrics. The doctors are beginning to develop
their own competency standards and rubrics. Moreover, the rubrics for the four cadres obtained from
the DOH are not specific to measuring the competency level of the health workers in delivering TB or
FP services. Therefore, before the actual competency mapping can be conducted by
HRH2030/Philippines, TB and FP rubrics will need to be developed.
The review revealed the need to consolidate all available competency rubrics, with the involvement of
professional organizations/societies and the DOH. HRH2030/Philippines aims to lead this effort using a
process that will engage all significant stakeholders, such as the DOH, societies for physicians, nurses,
medical technologists, and midwives, and other organizations involved in the technical competencies of
the four cadres.
Health Labor Market Analysis
During the HLMA scoping activities, the team, including the consultants who were engaged earlier for
the HLMA, realized that the health labor market in the Philippines was very complicated because of the
interplay of factors unique to the Philippines, such as the massive out migration of health professionals.
HRH2030 therefore reached out to WHO headquarters to determine whether there were new HLMA
tools that could be appropriately used in the Philippines. The activity also explored the possibility of
engaging WHO headquarters experts to assist in the development of an analytical framework and
approach that will lead to the preparation of policies that would ensure the effective recruitment and
retention of health workers at the primary care level, especially in marginalized areas. As a result of
HRH2030/Philippines Y1 Annual Report/4
these efforts, WHO agreed to engage its HR staff at headquarters, the WHO Western Pacific Region,
and the WHO country office, through joint missions, to assist the Philippines through the DOH in the
conduct of an HLMA to be completed in early 2019. Consequently, Dr. Pascal Zurn, the senior scientist
who developed the HLMA methodology and approaches, agreed to provide technical oversight and
work with local consultants to complete the HLMA using the latest tools and approaches.
Workload Indicators Staffing Need
Because the last national staffing standards were
developed in the 1980s, staffing ratios for the
Philippines are outdated. Unfortunately, investments in
HRH are still based on these staffing standards. A local
consultant group will implement and collect data for
the WISN. WHO will play a critical role in providing
technical oversight, from conceptualization to the
policy application of the staffing methodology. An
international consultant, Dr. Okech — a WISN expert
who has done relevant work in Africa and New Guinea
and who comes highly endorsed by WHO — came
onboard and has agreed to lead the WISN activity for
the Philippines.
She completed a scoping visit in October 2018 and
conducted orientation sessions for HHRDB-selected
members of the Technical Task Force, which will be the core data collectors for this activity. The
orientation sessions were important to gain buy in from the potential field sites and inform the potential
participants about the methodology and the rigor and objectivity that it requires. The WISN results are
due by March 31, 2019. They will inform implementation of the proposed Universal Health Care (UHC)
Bill, which is expected to be signed into law in December 2018.
Objective 2: Strengthen human resource for health leadership, governance, and
performance management
Current pre-service medical and paramedical courses do not include FP or TB
modules, resulting in a health workforce that is not fit to practice in public health settings and,
subsequently, the need to train them through in-service training often conducted in off-site venues,
resulting in the absence of service providers from facilities. Although many health personnel are trained
by various health courses, the promptness, coverage, and management of supportive supervision
activities need improvement to reduce the number of trainees who do not practice or who have not
achieved the quality standards needed for certification. Under this objective, HRH2030 will harness
available technologies to better deliver training activities, work with academic institutions to improve in-
service training, and strengthen supportive supervision.
HRH2030 conducted network building and consultative meetings with various partners and stakeholders
who were identified as potential sources of rich information because they were recognized practitioners
or implementers and advocates of the three key result areas namely Integrated e-learning system
established; mentoring, supportive supervision, and monitoring systems strengthened; and Capacity of
DOH central and regional human resource for heath managers increased to improve support for HRH
performance. These interactions served as venues for learning and scoping activities. The consultations
engaged a wide gamut of resources to get diverse and all-inclusive perspectives. Non-DOH and
implementing partners’ programs in areas other than health were likewise consulted if they were
anchored in governance, leadership, and supervision.
In a joint mission with the WHO, HRH2030 visited
various facilities in Cavite to demonstrate the
service delivery network that will be the context of
the forthcoming Philippines UHC. The first visit of
the WHO experts concluded with a soft
introductory training of the DOH technical staff on
WISN and NHWA. (Photo by: E
Gallardo/HRH2030)
HRH2030/Philippines Y1 Annual Report/5
Evaluation of In-Service Training Designs and Pedagogy to Inform the e-Learning Approach
HRH2030/Philippines collected training materials from the DOH and USAID for FP-related training
programs and training materials for the programmatic management of drug-resistant TB from the Lung
Center of the Philippines. These materials were analyzed to determine the training approach, and the
content and quality of current IST programs, especially on TB and FP/MCH. It was found that these
training materials do not lend themselves to learning modules that can be used for more efficient
competency enhancement involving many learners at the same time. Moreover, adult learning pedagogy
was not well used in engaging learners to achieve competency enhancement, even in specific programs
such as TB and FP/MCH. The assessment results identified gaps in training designs and implementation
that will be addressed by the e-learning methodology to be launched by HRH2030 in March 2019.
Assessment of Existing IST e-Learning Platforms and Digitized Learning Materials. Consultation
with the HHRDB in the first three quarters of Year 1 showed that although the DOH has initiated the
adoption of the Learning Management System /blackboard platform using Microsmith technology, it is
still in its infancy stage. The HHRDB is currently in the process of developing curricula and collecting
modules and courses on various health programs from such partners as Adolescent Health Education
and Practical Training (ADEPT). A review of existing e-based systems developed by the previous USAID-
funded project, VisayasHealth, showed the potential benefits of e-learning systems. The benefits include
reducing the costs per learner in terms of time to get certified to do certain functions, and eliminating
indirect costs, such as hotel and travel expenses. The e-learning systems also reduce health personnel’s
absenteeism from their posts due to participation in training.
During the period, the project also engaged an American International Health Alliance (AIHA)
consultant who was tasked with undertaking a work scoping of the DOH’s readiness for e-based
learning systems. Dr. Roxanne Zagab completed the e-learning status assessment and provided useful
recommendations that will drive HRH2030 efforts to promote and implement e-learning, especially for
the NTP and FPP. The consultant will also provide cutting edge information on the e-learning platform
options that are sustainable for the Philippines. The DOH should select one platform that it is willing to
use and continue to use beyond the HRH2030 project life.
Assessment of Mentoring, Supportive Supervision, and Monitoring Systems
Findings from field visits and consultations revealed
that there are no official guidelines on supportive
supervision even though a three to six-month post-
training evaluation is required. The regional levels
are extensions of the central DOH, however there
are no designated individuals at the regional offices
to provide supportive supervision, rather program
managers that unofficially fill that role. Timely
conduct of CMSS is not regular because supervisors
are local government unit (LGU) personnel who are
not allowed to do supportive supervision.
A review of related materials and the collection of
initial information were conducted through one-on-
one scoping and meetings with DOH and non-DOH
stakeholders. Findings provided input for the
development of concept notes to inform the scopes
of work (SOWs). Concept notes were refined and a job description for short-term technical assistance
(STTA) on assessments of CMSS and HRH competency-based performance management were finalized.
AIHA consultant Roxanne Zaghab (leftmost)
presents to the DOH her assessment findings
and options for implementing an efficient e-
learning system that magnifies outreach to health
workers on continuing professional education.
(Photo by: A Pascua/HRH2030)
HRH2030/Philippines Y1 Annual Report/6
Assessment of the Status of the DOH Academy
In 2015, the DOH recognized the need to support the “successful and efficient implementation of health
reform strategies by HRH under the UHC agenda by rationalizing Learning and Development
Interventions (LDIs) in LGU health facilities including the private service providers in Service Delivery
Networks (SDNs).” Through the issuance of Administrative Order No. 2015-0042, the DOH Academy
got its mandate as the “primary training arm of the DOH in building the competencies of HRH.” Various
efforts were undertaken, and policy guidelines were enacted by the DOH over the past years, which laid
the groundwork for the creation of a DOH Academy that is envisioned to exercise stewardship in
providing Learning and Development Interventions (LDI) that are relevant, rationalized, and responsive
to the dynamic needs of the health sector. However, frequent changes in the DOH administration have
stalled initiatives by the HHRDB’s Learning and Development Division. In the absence of clear direction
for the future of DOH Academy, HRH2030 will focus on strengthening this as a hub for the eLearning
platform.
Objective 3: Improve the use of data for health workforce decision-making at central and
regional levels
The HHRDB reports that although there are several information systems that capture HRH data (Field
Health Services Information System [FHSIS], National Database of Selected Human Resources for
Health [NDHRIS], Professional Regulation Commission [PRC] licensure database, Commission on
Higher Education [CHED] for medical graduates, and Overseas Workers Welfare Administration
[OWWA] out-migration data for medical professionals), 73 percent of the estimated total health
workforce remains unaccounted for. This absence of information on roughly two-thirds of the health
workforce has made the development of policy support unresponsive and has led to the adoption of
measures as stop-gap solutions. Capacity building activities for FP and TB have been a recurring activity
over the years; however, there is no information on the coverage of training and post-training support
activities for the cadres, and the community support groups or volunteers who are important for
improving compliance with TB treatment regimens or continuance of FP use.
In Quarter 4, activities focused on two key interventions, namely, the HAF assessment of HRH data
systems, and the identification of HHRDB, FPP, and NTP’s HR data management requirements.
Conduct of the HAF
The HAF provides a structure for assessing the development stage of a country’s HRIS by measuring the
functionality and capacity of the HRIS. Eight components of functionality and eight components of
capacity are assessed as shown in the table below.
Table 1. HAF Areas Assessed
Domains of HRIS Functionality Assessed Domains of HRIS Capacity Assessed
Pre-service education
Registration and licensure
Staffing gaps and needs
Payroll information
Personnel actions
In-service training
Workforce Exit/attrition
Health Worker Registry
Technology Infrastructure
Decentralization of Access
Use of standards
Data quality
Sustainable financing
Human capacity
Interoperability
Use of data
HRH2030/Philippines Y1 Annual Report/7
In the first three quarters, HRH2030/Philippines worked closely with the HHRDB to apply the HAF for
the HRIS assessment. Together with the HHRDB, this tool was applied to 20 information systems
managed by stakeholders in the HRH Network and the DOH. In the fourth quarter, HRH2030
disseminated the results of the HAF during the HRH Network quarterly meetings and during the
development of the Year 2 workplan, in collaboration with the DOH. These activities provided a venue
to strengthen collaboration among DOH bureaus that collect HRH data and/or manage the HRIS. A
report on the HAF assessment has been completed and submitted to USAID. During the HAF
workshop, representatives from the HHRDB, Health Facilities and Services Regulatory Bureau (HFSRB),
NTP, FPP, and Epidemiological Bureau agreed to adhere to data standards and guidelines once they are
finalized and to the adoption of a minimum dataset for a training registry.
Assessment of HRH Data Systems in and Outside the DOH
To assist the HHRDB to take steps to improve the current health workers database, HRH2030 assessed
available data and information systems and consulted the gatekeepers of HRH information. Using 2016
data provided by the HHRDB, an assessment was conducted. From the database, a listing of public and
private facilities that have submitted their HR reports will be compared with similar lists from the DOH
master list for the HRH target sites to identify non-reporting units, conduct consultations to identify
reporting issues, and assist the HHRDB to improve overall reporting through the drafting of reporting
templates or guidelines to improve the quality of current HR data. HRH2030 also initiated discussions
with the HHRDB division heads and technical staff to determine the information requirements for
managing (1) the mapping of competency gaps to available training; (2) individual and aggregate-level
training reports; and (3) staff competency, deployment, and distribution. Last, HRH2030 initiated
separate discussions with the FPP and NTP offices to define their HRH information requirements.
Information from the assessment will provide data on data completeness and relevant data needed for
the NHWA.
Discussions with Dr. Yolanda Oliveros, Development
Assistance Specialist, USAID/Philippines, on improving the
management training information led to subsequent
meetings with NTP and FP coordinators and a consultative
workshop with selected TB and FP program coordinators at
national and regional levels. Current training information
systems are unstandardized, programmatic, and limited in
use for managing performance and continuing development
of health workers’ training needs. The consultations
provided insights for the design of a training information
system that will be integrated in the performance
management process, especially on the implementation of
the performance improvement plan for cadres. HRH2030
also worked with the HHRDB’s Learning and Development
Division to document current HHRDB processes, and the
desired scope of data and functionality, stakeholders and learning management system technology as
part of the requirements-gathering process. This activity helped identify the strengths and weaknesses of
current processes and was useful in designing the desired future improvements.
HRH2030 also met with the NTP Program Manager and Family Health Office (FHO) Division Chief to
determine their respective health worker data and information requirements. HRH2030 will conduct
follow up meetings next quarter to gather data/information requirements from the NTP and FPP to
identify common themes in the FP and TB training modules. They will be used to develop TB and FP
provider directories that are included in the programs’ identified strategies.
Units of the HHRDB threw in ideas to firm up
the bureau’s identity as managers of health
human resources.
(Photo by H Doroteo/HRH2030)
HRH2030/Philippines Y1 Annual Report/8
Planning for National Health Workforce Accounts Reporting and Use of Data for Decision-
Making
HRH2030 supported the DOH in the implementation of the NHWA in the Philippines in a joint mission
with the WHO. HRH2030, the DOH, the WHO Country Office, the WHO Western Pacific Region
Office, and WHO headquarters collaborated to engage and orient stakeholders on the NHWA. The
stakeholders were the CHED, PRC, Commission on Filipinos Overseas, Philippine Overseas
Employment Administration, Department of Labor and Employment, Philippine Statistics Authority,
selected LGUs, regional NTP and FP coordinators, and DOH bureaus. During the joint mission, the
team visited Cavite to conduct a rapid scoping of HRH data management at different health facilities and
at different levels. HRH2030 and WHO also supported the DOH in designing the first draft of the
NHWA implementation roadmap.
Proposed implementation plans for both the NHWA and WISN were drafted at workshops. For the
NHWA, the priority interventions agreed on with the HRH Network were (1) engaging the heads of
different agencies contributing NHWA data to have a joint agreement on data sharing; (2) establishing a
core group in the HRH Network to operationalize the agreement and develop data reporting guidelines
with standard templates for reporting, the standardized information to be reported, a data dictionary,
and a reporting flow; (3) addressing data sharing issues vis-a-vis the Data Privacy Act; (4) preparing a
NHWA report to be disseminated to the HRH Network and developing technical briefs that will aid in
policy development; and (5) strengthening the NDHRIS readiness to receive information through the
mapping of HRH data and processes, and through capacity building for the HRH network for the
extraction of data, and their analysis and dissemination. A proposed roadmap for the implementation of
the NHWA was presented to the Undersecretary of Health, Rolando Enrique D. Domingo, and the
Undersecretary of Health, Mario C. Villaverde.
Cross-Cutting 1: Organizational Development for the DOH (HHRDB, FHO, NTP)
HRH2030 initially envisioned Organizational Development (OD) as a cross-cutting component
embedded in the three activity core objectives (post-baseline assessment) to build stakeholder capacity
to adopt and institute recommended HRH solutions and transformative interventions. Following several
meetings with stakeholders and refinement of the work plan, the OD needs, and requirements
expanded beyond the activity objectives to support HRH system improvements and to create a better
practice environment, namely:
• To undertake institutional capacity building for the HHRDB (Result 4.1)
• To develop a model to enhance the patient experience (PX) in the healthcare setting (Result
4.3)
• To undertake institutional capacity building for the NTP and FHO (Results 4.5 and 4.6)
Institutional Capacity Building for the HHRDB As the lead DOH unit for sectoral HR concerns, the HHRDB is instrumental in spearheading initiatives
that will address prevailing HRH-related challenges, including the skills mix and maldistribution of health
personnel. With the support of the HHRDB’s Management Committee, HRH2030 launched the HHRDB
baseline assessment, which examined the bureau’s mandate, strategy, structure, processes, and people.
Key accomplishments in this process during Year 1 were:
A. In-depth interviews (IDIs) with the HHRDB Management Committee members:
HRH2030/Philippines completed IDIs with the four members of HHRDB’s Management Committee.
This qualitative research used a structured questionnaire administered through individual interviews.
Clarity of its mandate and direction remain a core challenge because the bureau continues to
HRH2030/Philippines Y1 Annual Report/9
receive organization-related HR assignments despite the existence of the Personnel Administration
Division.
B. Value chain analysis with preliminary strengths, weaknesses, opportunities, and threats
(SWOT) analysis: HRH2030 provided technical assistance for the HHRDB to identify its value
chain — a series of four to six critical bureau processes that add value to its stakeholders and
support its mandate. Each process in the value chain was subjected to a SWOT analysis to
determine the challenges that prevent the bureau from managing HRH issues effectively in the
sector. The identified challenges will be validated through meetings and executive interviews under
the context of the new F1+ DOH Strategy.
C. HHRDB vision-mission-values clarification workshop: HRH2030 provided technical
assistance to enable the core team of the HHRDB, composed of 15 personnel, to review its vision-
mission-values and ensure responsiveness to its sectoral HRH mandate. The team proposed new
values and a mission statement. The vision statement will be finalized pending input from and
discussions with the DOH leadership and its defined role in the F1+. The bureau also started to
identify components for its broad-level direction until 2022.
D. Stakeholder consultation on the proposed HRH2030-HRMD Framework: HRH2030
developed the proposed HRH2030-HRMD Framework — which identifies 12 core HR subsystems
— to create a common reference for integrating the different objectives and components of the HR
system. HRH2030 consulted existing HR tools and frameworks from the Civil Service Commission
(CSC), WHO, and HRH Action Framework, to design tailored elements of the HRMD Framework.
HRH2030 validated the framework with more than fifty public, private, and health practitioners,
which signaled a need for a common framework and concerted initiatives for sustainable HRH
impact. The country’s leading association of HR practitioners, People Management Association of
the Philippines, reviewed and enthusiastically welcomed the framework.
E. Documentation of job responsibilities initiated: HRH2030 began the documentation of job
responsibilities to capture information related to actual work responsibilities, knowledge and skills
required, level of decision-making, and supervision requirements from an incumbent’s point of view.
HRH2030 completed 10 percent of the bureau’s inputs that will be used in the WISN and Rapid
Task Analysis exercises in Year 2.
HRH2030 also established linkages with relevant stakeholders and agencies to align plans, including with
the CSC, the main government entity to elevate public sector HR management and development
practices; the Philippines-Australia Human Resource and Organizational Development Facility
(PAHRODF); and the Personnel Administration Division (PAD) of the DOH.
Development of a Model to Enhance the Patient Experience in the Healthcare Setting
HRH2030 aims to better understand and address the PX in the public and private healthcare setting,
especially to inform HRH strategies to better deliver TB and FP/MCH services. In Year 1, HRH2030
completed a literature review and consultations to develop an appropriate approach. Studies on the PX
largely come from other countries, and best practices and lessons learned must be adapted to develop
the concept in the Philippines.
The following activities were implemented:
HRH2030/Philippines Y1 Annual Report/10
A. Focus group discussions with Samahan ng Lusog Baga: HRH2030 engaged members of the
Samahan ng Lusog Baga Association — a TB patient support group composed of former TB patients
(mostly former multiple drug-resistant TB
patients) to obtain input and information on
the factors that affected their experiences
while battling TB. Participants shared their
stories and the difficulties they encountered
as patients, including feeling discriminated
against and burdened when accessing health
services in their own communities.
B. Field observation of TB and FP
practices in two municipalities:
HRH2030 visited the municipalities of
Balanga, Bataan and Catbalogan, Samar to
learn more about how TB and FP programs
are implemented at the primary care level.
Through these visits, HRH2030 identified
critical factors to look at during future field visits to other primary care sites.
C. Buy in from a large hospital implementing PX secured: HRH2030 met with St. Luke’s
Medical Center, one of the largest private hospitals in the Philippines. The hospital has been
implementing the PX for several years and expressed interest in co-implementing a proposed two-
day PX conference.
D. Preparations for case study research: The field observations helped ground our assumptions,
but the absence of local studies on the PX prevents a richer understanding on which to build an
implementable framework. In Year 1, HRH2030 developed a SOW and requested proposals to
conduct case study research to develop a methodology and collect qualitative data to document
current practices on the PX, with a focus on TB and FP/MCH services. The research will explore
definitions and impressions about the PX, and will compare experiences between private and public
institutions and across different healthcare settings.
Due to expanding the scope of the case study PX research, Year 1 deliverables will be continued in Year
2 to inform prototypes to be tested at select pilot sites.
Institutional Capacity Building for the NTP and FHO
In Year 1, HRH2030 met with the program leads of the NTP and the WMHD, which is the lead for the
FP program. These meetings mapped out key challenges that will be crucial in designing the baseline
assessments for Year 2.
A. Interviews with DOH leadership executives on TB and FP directions: HRH2030 started
conducting interviews with members of the DOH Executive Committee, including the Secretary of
Health and Assistant Secretaries, to better understand how the TB and FP programs are progressing
and identify priorities for future directions. Several DOH executives expressed the need for broad-
level review of the programs’ strategies and approaches given the state of outcomes achieved in past
years.
B. Interviews with TB and FP resource persons: HRH2030 met with key DOH leaders managing
the TB and FP programs, who expressed concerns about sustainable staffing. Although the NTP has
a significant budget allocation, most of its workforce is contracted by the Global Fund to Fight AIDS,
Tuberculosis and Malaria (Global Fund). The program therefore faces a great risk and is not
sustainable if funding from the Global Fund ends. Leaders also reported that the FP program’s
strategies should be revisited to help determine a better structure and activities.
HRH2030 explored the elements of the patient experience with an
initial focus group discussion with the Samahan ng Lusog Baga
Association, Inc. (Photo by: H Doroteo/HRH2030)
HRH2030/Philippines Y1 Annual Report/11
C. Program Implementation Reviews secured: HRH2030 obtained the Program Implementation
Reviews for the TB and FP programs, and started documenting HRH-related challenges to be
validated and addressed in Year 2.
Change Management Support for Objectives 1 to 3
Assessments and stakeholder engagement allowed the HRH2030 OD team to better understand the
current systems and context that will affect the deployment of key transformation initiatives for
Objectives 1 to 3. As the different objective teams proceed with their assessments, key organizational
challenges will be identified and supported through capacity building approaches. Based on preliminary
information, there is a crucial need to clarify the interface between and among bureaus to ensure
synergistic and aligned HRH initiatives, including:
• At the central office level, define the collaboration, responsibilities, and functions between the
HHRDB and the PAD.
• At the DOH hospital level, clarify how the HHRDB and PAD can develop and enhance systems,
regulations, and standards with the support of the HFSRB and HFDB.
• At the LGU and SDN levels, prepare models for the HHRDB, PAD, regional offices, and the
Bureau of Local Health Development (BLHD) to coordinate and champion quality HRMD
systems in the different health units under the administration of the LGUs.
The same approach will be used for capacity building and sustaining change initiatives in implementing
other pilot interventions under HRH2030 objectives, including competency standards, distribution and
staffing levels, staff augmentation, e-learning, performance management, and supportive supervision.
Similarly, for HR and training data management and information systems, identifying the roles and
responsibilities between the HHRDB — the expected user of data and official link with the HRH
Network — and the Knowledge Management and Information Technology Service — the technical
custodian of information technology and information systems in the DOH — should be explored and
defined.
Cross-Cutting 2: HRH Policy Environment Strengthened
The cross-cutting policy component aims to assess, advocate for, and implement policies that support
the other components. HRH2030 uses proven and tested methodologies that enhance policy initiatives
to support the achievement of programmatic interventions and outcomes of its activities.
Conduct a Scoping Assessment of HRH Policies In Year 1, HRH2030 initiated a policy scoping activity
to identify DOH priority issues and policy
standards, and it began to collect qualitative
data. The policy scoping activity was designed to
cover the following areas: (1) review HRH
policies, both internal and external to the DOH;
(2) identify HRH stakeholders; (3) identify
information use among decision-makers; (4)
assess policy implementation; and (5) identify
HRH issues needing qualitative studies.
HRH2030/Philippines held meetings with
representatives from the HHRDB and Health
Policy Development and Planning Bureau
(HPDPB) to gain their buy in for the policy
scoping assessment and assist them in identifying
policy priorities that HRH2030 can address over
the next three years. The DOH identified three
priority issues for assistance: the Return Service
Agreement (RSA), omnibus policies on
HRH2030 consulted key stakeholders from public and private
sector at different levels to find out what policies related to health
workers pose challenges in implementation and what policies
effectively address health worker needs. On right is City Health
Officer of Catbalogan City Dr. Gerarda Tizon. (Photo by R
Daquioag/HRH2030)
HRH2030/Philippines Y1 Annual Report/12
deployment and training, and the HRH Network Bill. Following these introductory meetings, HRH2030
designed a policy scoping plan that outlined the methodology for collection and analysis of policy-related
information.
Policy development plan aligned with DOH priorities developed
By the end of Quarter 4, HRH2030 had reviewed a total of 54 policy issuances, revealing the presence
of laws and policies that mandate professional development, deployment, training, and supervision of
health workers and the creation of a HRIS. Despite the presence of some HRH-related policies,
challenges exist in implementing them. Policy guidelines and their implementation are fragmented and
are not effective in some HRH programs, such as the deployment program, leading to issues with
distribution, roles and functions in the primary healthcare team, and workload for the deployed HRH.
Inventory of HR policies completed and gaps identified
HRH2030 also identified policy gaps and a lack of standards for HRH competencies, skills mix and
distribution, leadership, and performance accountability. As regards HR information, policies are lacking
for a central custodian responsible for HRH data and standards for information sharing and exchange.
HRH policies are needed to mandate the RSA, strengthen leadership and performance management
capacities, and establish HRH standards for service delivery networks to ensure the availability of HRH
in every health facility. The HRH Network, as the main interagency mechanism to implement the HRH
Masterplan, needs a more permanent organizational mandate to develop and implement HRH policies.
Findings from the analysis of existing policies and gaps will be used for the development of technical
assistance packages (e.g., performance management standards, HLMA, WISN, NWAH, e-based learning
platforms) and identify enhancements needed in drafting relevant policy changes.
In addition to document review, HRH2030 conducted 10 key informant interviews (KIIs) and 16 focus
group discussions with selected DOH national, regional, provincial, city, rural, and barangay offices and
members from the private and academic sectors. HRH2030 completed a preliminary policy scoping
report to present the initial inventory of HRH policies, findings, and proposed next steps. Findings from
the KIIs provided the context for assessing the operational issues needing policy enhancements.
Key Challenges
Major challenges that affected the pace of implementation were: (1) difficulties coordinating with non-
DOH partners; (2) uncertainty about the policy direction of critical technical packages, such as the
enhancement of the DOH Academy, performance assessment coverage, and methodology; and (3)
changes in the administration of key DOH units (e.g., DOH regional offices, NTP, HHRDB).
Rotation of assignments among DOH Executive Committee members (twice in the last five months) led
to challenges in conducting interviews and identifying potential HRH champions who can help push
initiatives. During the period, HRH2030 advocated for project support at the National Staff Meeting and
arranged for high-level meetings, together with the WHO, to elicit directions for the development of
the WISN and NWAH.
HRH2030 was also challenged in selecting SDN project sites due to the coordination and consultation
processes needed for the methodology, indicators, and sources of reliable data with its partners in the
DOH (HHRDB, FPP, NTP) and other USAID implementing partners. During the period, field visits were
conducted to regional health offices to discuss the selection process with regional local health systems
and program personnel, identify service delivery networks, and discuss Year 2 activities.
Early difficulties in the scheduling of needed international and local consultants were facilitated with
support from the Chemonics home office.
HRH2030/Philippines Y1 Annual Report/13
Project Management
Monitoring, Evaluation, Learning and Adaptation
Performance Management. HRH2030 submitted a draft Monitoring, Evaluation, Learning, and Adaptation
(MELA) Plan to USAID on April 24, 2018, describing the key result areas for which the activity
contributes to U.S. government (USG) goals and HRH2030 global objectives, along with an indicator set
for measurement. With the baseline data collection scheduled for completion by the end of Year 1, the
activity does not yet have targets and baselines. A revised plan was submitted on July 7, 2018 containing
two USG, 17 internal, and five global HRH indicators.
Selection of priority sites for testing HRH tools and assessment. During the period, the activity went through
a process of selecting regional sites with the following criteria: a) high TB burden; b) high unmet need
for FP; c) high teenage pregnancy; d) high poverty incidence; and e) low HRH density index. In
coordination with the Collaboration, Learning and Adaptation (CLA) project and the DOH, a consensus
was reached identifying nine regions with 18 provinces/cities. Regional visits were conducted to consult
regional health offices, update the indicators used in the criteria, validate the provincial/city selection,
and identify SDNs. This information is summarized in Table 1.
Table 1. HRH2030 Sites for Activity Implementation Regions Provinces/Cities
Luzon
National Capital Region Manila (HA)
Marikina City (LA)
Region 3 – Central Luzon Bataan (HA)
Zambales (LA)
Region 4a – CALABARZON Batangas (LA)
Lucena City (HA)
Region 4b – MIMAROPA Palawan (LA)
Mindoro Oriental (HA)
Visayas
Region 7 – Central Visayas Cebu (HA)
Bohol (LA)
Region 8 – Eastern Visayas Tacloban (HA)
Eastern Samar (LA)
Mindanao
Region 11 – Davao Region Davao Oriental (LA)
Davao City (HA)
Region 12 – SOCCSKSARGEN Sultan Kudarat (LA)
General Santos City (HA)
Autonomous Region of Muslim Mindanao Lanao del Sur (LA)
Tawi-Tawi (HA) *HA – high access, LA – low access
Harmonization with other cooperating agencies and DOH TB programs. During the reporting period, two
meetings with the CLA project and partners resulted in improvements in the complementarity of
HRH2030 activities/approaches with other efforts in HR development, including e-learning.
For the harmonization meeting with the NTP, an inventory of official development assistance for the TB
program showed USG support areas for each of the Philippine Strategic TB Elimination Plan (PhilSTEP)
strategies. The following are the HR indicators in the PhilSTEP:
1. Percentage increase in the number of LGU-hired TB health care providers (target in 2018: 5%,
2019: 10%)
2. Percentage of DOH-deployed human resources involved in TB elimination efforts (target in
2018: 50%, 2019: 90%)
HRH2030/Philippines Y1 Annual Report/14
3. Percentage of human resources performing tasks according to NTP protocol (target in 2018:
90%, 2019: 90%)
Common HR-related activities focus on programmatic capacity building, including supportive supervision
and patient satisfaction/experience.
Participation in project management learning activities. In Quarter 4, HRH2030 attended project
implementers’ meetings convened by the mission, including: Preventing Sexual Misconduct,
Documentation, Outreach and Communications (DOC) Outreach Session, and CLA sessions.
Communications
HRH2030 communications is led by a local staff member and is supported by a global team based in
Washington, D.C. In Year 1, HRH2030/Philippines contributed to biweekly internal updates (which are
distributed to HRH2030 global staff worldwide), website content development, and social media
publications. HRH2030 also contributed to the USAID/Philippines’ social media platforms and the
Philippines Health Highlights publication. Two events marked the major communication pieces for Year
1: the HRH2030 launch and the introduction of the HRH2030-WHO joint mission.
Publications. The activity was featured in two issues of the USAID/Philippines Health Highlights: the soft
introduction of the activity (“USAID Launches New Project to Expand Access to Quality Health
Services,” published April 9, 2018) and the formal launch event in May (“USAID, DOH Launch Project
to Strengthen Philippine Health Workers,” published June 18, 2018).
The communications team used both mainstream and social media to disseminate information about the
activity when it was formally launched in May. In June, the mission’s DOC Office commended HRH2030
for reaching 17,600 people with more than 1,400 engagements in a week.
Branding and Marking. During the period, the Philippines activity worked closely with the global program
and the mission to clarify concerns about branding and marking. The issues have been addressed with a
more detailed global branding and marking plan resubmitted and approved by the USAID/Washington.
HRH2030 also worked closely with the WHO and the global program to ensure proper co-branding for
all activities related to the joint mission.
Mobilizing Investments for the Philippines’ Health Workers. In April, HRH2030 participated in the
Washington-led International Health Workers Week Campaign by submitting social media materials to
the mission and the global program.
In August, the activity started a communications project with local health workers, interviewing 15
health workers (three doctors, four medical technologists, four nurses, three midwives, and one
member of a TB patient support group) about their personal lives, professional situations, and hopes for
the Philippines health system (for example, asking them what would make them more productive health
workers). In Year 2, the communications team will work to develop these profiles into stories and other
content for local and global dissemination, including features around TB month (March), International
Women’s Day (March), and International Health Workers’ Week (April) in 2019.
3. Performance Status Per Key Indicator
HRH2030 is a health system strengthening activity that contributes to two sub-purposes in the USAID
Results Framework, especially in the following areas:
Sub-purpose 2: Quality of Services Fortified 2.1 Improved quality health service through patient-centered approaches
Sub-purpose 3: Key Health Systems Bolstered and Institutionalized 3.2 Critical state of the art training institutionalized and sustained by DOH
HRH2030/Philippines Y1 Annual Report/15
3.3 Improved fiscal, financial and human resource management for health institutionalized at
the central, regional and local level
For reporting purposes, the activity provides updates on two USG indicators: (1) Presence of mission
(USAID/Philippines) support to strengthen HRH and (2) Percent of health workers who received in-
service training in FP and TB using non-traditional learning platform in USG-assisted sites.
Below is the status of the activity’s performance against these indicators as of the end of the fiscal year.
There is no progress reporting for the second USG indicator because HRH2030 began development of
the e-based learning platform in Year 1. Other non-USG indicators in the HRH2030 MELA Plan,
including indicators for global reporting, are detailed in the annexes (8.1).
Activity Performance on Presence of Mission (USAID/Philippines) support to Strengthen Human
Resources for Health (HRH). HL-2 (USAID)
Indicator Baseline Accomplishment
For the Quarter
Cumulative
Accomplishment to Date Presence of Mission
(USAID/Philippines)
support to Strengthen
Human Resources for
Health (HRH). HL-2
(USAID)
Yes
Target
Yes
Actual
Yes
%
Target
Yes
Actual
Yes
%
Analysis of Accomplishment 1. Rollout of the NHWA (or database) to improve workforce data for decision-
making
WHO and USAID HRH2030 supported the implementation of the NHWA in the Philippines. Key
stakeholders on NHWA were oriented and a workshop led to the development of a country roadmap on
NHWA implementation in the Philippines.
2. Advocacy for and an increase in allocation of funds for HRH
The project’s technical support was mainly focused on national implementation partners, such
as the DOH’s HHRDB, FPP, and NTP. In Year 2, HRH2030 will advocate for the allocation of
budget for implementing activity-supported HR systems strengthening at national, regional, and
local levels using the analyses from the WISN and HLMA.
3. Upgrading the skills mix (various types and level of skills required in reference to
the type of health providers)
Capacity building is accomplished through technology transfer to HHRDB staff because the
HRH2030 team mentored them during the conduct of assessments, tools development, and
scoping activities. For Year 1, the focus was on the development of competency rubrics for
doctors, nurses, midwives, and medical technologists.
Deviation Narrative
•
Plan for the Next Quarter
• For WISN, conduct of training for WISN data collectors, analysts; development of activity
standards, estimation of health worker staffing needs.
• For the HLMA, data collection and analysis.
• Develop an online course on FP and TB.
HRH2030/Philippines Y1 Annual Report/16
3.1 Key Challenges and How They Are Being Addressed
Major Challenges Proposed Action (updates
provided in succeeding quarters)
Next Steps (Activities) Timeline Responsible Party
Objective 1: Improve the effective skills mix, competency, and distribution of the health workforce at the primary care level
HLMA research protocol
not yet completed.
Technical oversight and vetting
ongoing between HRH2030 head
office and field office for the approval
Submission to Ethics Review and
organization of the team on the
ground to start collecting data.
Y2 Q1
Chemonics head office and field
office
Restrictions of current
national policies on
potential activity
intervention designs, i.e.,
Personnel Services cap in
hiring additional health
workers, following the
provisions of the Local
Government Code.
Identify potential restrictive
laws/policies that may limit HRH2030
interventions and raise these
laws/policies with the HHRDB-DOH
or the HPDPB-DOH to solicit
potential actions.
1. Identification of restrictive
laws/policies and relating
them to potential activity
interventions.
2. Presentation of identified
restrictive laws/policies.
3. Identification of next steps to
be taken by HRH2030 or the
DOH.
End of August 1. Objective leads per
component of HRH2030
2. Dr. Fely Marilyn
Lorenzo, with Objective Leads
3. Dr. Fely Marilyn
Lorenzo, with Objective Leads
and DOH key decision-makers
Objective 2: Governance and Leadership
DOH and stakeholders’
sustainable buy in on
assessment findings (E-
learning, HRH, CMSS).
Report sharing.
Solicitation of feedback on the
assessment report.
Stakeholder consultations and
workshop.
Development of Year 2 plans and
directions.
• Enhance design of e-
learning systems and CMSS
assessment
• Feedback on enhanced
designs to HHRDB
Q4
September 2018 or
early Oct 2018
End of Sept 2018 or
early Oct 2018
Roxanne Zaghab (RZ) – AIHA E-
learning consultant
Final Report of AIHA RZ to be
disseminated by HRH2030
Chemonics terms of reference
and contract with AIHA
AIHA RZ and HRH2030
Objective 3: Information for Decision-Making
Access to a readily
available and timely
structured data.
Focus on the available HRH data
related to TB and FP
Work with the HHRDB and HRH
Network based on agreements in
the NWAH discussions during the
joint review.
Y2 Q1 Objective 3 lead and team
Standards for recording
and reporting of training
Review existing training information
systems and prepare recommended
standards.
Consultation meetings with users of
training information.
Y2 Q2 Objective 3 lead and team
HRH2030/Philippines Y1 Annual Report/17
Major Challenges Proposed Action (updates
provided in succeeding quarters)
Next Steps (Activities) Timeline Responsible Party
information not
established.
Develop integration design and
proposed standards.
Organizational Development
Rotation of assignments
among DOH Executive
Committee members
(twice in the last five
months) resulted in
challenges in terms of
conducting interviews and
identifying potential HRH
champions that can help
push initiatives.
Activity engagement should be
endemic to the DOH, making the
Secretary and the rest of the DOH
Executive Committee fully engaged.
This will sustain the activity’s
momentum even with changes and
rotations in assignments.
Update: The Project Director
continues to work on building strong
buy in from the DOH leadership and
presented the project to the DOH
Executive Committee during the
National Staffing Meeting in Cebu.
At the objective level, HRH2030 has
decided to carry out interviews with
all members of the DOH Executive
Committee. Although this may
prolong the process, it is necessary to
make sure that all perspectives are
factored in and that the process will
not be affected even when another
round of rotations among DOH
executives occurs.
Demonstrate flexibility in engaging
DOH stakeholders.
Update: Complete interviews with
the DOH.
Q4 and continuing
Y2 Q1 and Q2
Project Director with the OD
team
The absence of a full-
fledged appointed HHRDB
Director poses a risk to
the interventions being
sustained.
Create critical support for
interventions from within the
organization and the cluster to which
it reports.
Engage the different levels in the
HHRDB, from the job orders
Create an intervention plan for the
HHRDB based on identified OD
needs of the bureau.
Y2 Q2 OD Adviser and Project Director
HRH2030/Philippines Y1 Annual Report/18
Major Challenges Proposed Action (updates
provided in succeeding quarters)
Next Steps (Activities) Timeline Responsible Party
(intermittent positions), entry-level
personnel to the division chiefs.
Update the cluster team leader
(usually an undersecretary) on
developments and capacity building
plans for the HHRDB to create
support.
The upcoming 2019 local
elections may create
leadership changes that can
affect the implementation
of interventions at the
SDN level.
Engage both national and local leaders
in the delivery of SDN-level
interventions. Engage regional staff
and DOH representatives on the
ground to buy in and champion the
interventions. At the local level, work
not just with the municipal and
provincial leaders, but also barangay
leaders (since barangay leaders are
not due for election). Strengthen the
involvement of the private sector and
other key stakeholders, when
applicable.
Do orientations on the PX at the
SDN site level involving all key
stakeholders: DOH personnel from
the region, provincial and municipal
leaders, barangay-level leaders, and
key stakeholders.
Y2 Q2 Communications Manager with
the OD Adviser
Change takes time and
initiatives must be
sustained beyond the life of
the project.
Start linking up with other USAID
projects; agree on approaches that
will be used to ensure that project
outputs (especially the PX) can be
sustained after the project ends.
Influence the development of the
HHRDB’s strategic plan as the
primary unit in the DOH that can
sustain and mainstream the use of the
tools being used by the program.
Conduct implementation-level
alignment discussions with other
relevant USAID-funded TB and FP
projects.
Identify opportunities to provide
input for the development of the
HHRDB strategic plan.
Y2 Q2
Y2 Q2
OD Adviser with the Project
Director
OD Adviser with the Project
Director
Policy Development
HRH2030/Philippines Y1 Annual Report/19
Major Challenges Proposed Action (updates
provided in succeeding quarters)
Next Steps (Activities) Timeline Responsible Party
The UHC Bill has been
passed at the bicameral
session and submitted to
the President for his
approval.
Assist the HHRDB in the preparation
of proposed guidelines for the RSA,
which will form part of the
Implementing Rules and Regulations
(IRR) of the UHC law.
Support the HPDPB and HHRDB
discussions (e.g., comparative analysis,
additional tools/data, support funds
for consultations/forum) to ensure
that they have the necessary
resources that they need to develop
proposed RSA guidelines.
• Consolidate data on the RSA
model and enhance
components of the compulsory
service program.
• Present and discuss proposed
RSA components to the
HHRDB and HPDPB.
• Participate in the discussion of
the IRR for the UHC.
December 31, 2018
January 31, 2019
March 31, 2019
Policy Advisor and Senior
Technical Officer
Policy Advisor and Senior
Technical Officer
Policy Advisor and the Project
Director
The HPDPB and HHRDB
have different policy
priorities with regard to
HRH issues.
Policy priorities of the DOH in
relation to HRH issues have been
consolidated to include:
• Mandatory RSA for HRH
• Redistribution of the health
workforce
• Improvement of HRH
working conditions
• Strengthen leadership and
management capabilities
• Strengthen HR data and
information system
Conduct policy fora to identify
priority policy directions for each
priority policy issue.
Facilitate consensus on policy
direction and present to
mancom/execom
Y2 Q2-Q4 Policy Advisor and the Project
Director
Lack of policy standards
related to competencies,
skills mix, and distribution
Work with the Objective 1 Lead to
develop and recommend
enhancements to the Deployment
Program guidelines.
• Review and analyze policies on
deployment based on the HRH
policy inventory, policy
implementation review, and
results of the Deployment
Program assessment.
March 31, 2019
March 31, 2019
Policy Advisor and Senior
Technical Officer
Policy Advisor and Senior
Technical Officer
HRH2030/Philippines Y1 Annual Report/20
Major Challenges Proposed Action (updates
provided in succeeding quarters)
Next Steps (Activities) Timeline Responsible Party
• Identify gaps in the Deployment
Program guidelines and
recommend enhancements.
• Work with the HHRDB on the
revision of the Deployment
Program guidelines.
April 30, 2019
Policy Advisor, Objective 1 Lead
with the Project Director
Lack of policies related to
leadership, supervision, and
performance management
Work with the Objective 2 Lead to
develop and recommend
enhancements to the DOH Academy
to include e-learning platforms.
• Review and analyze policies on
the DOH Academy, including
assessment studies conducted
on the program.
• Enhance recommendations for
the use of e-learning platforms
for learning and skills
development.
• Work with the Objective 2
Lead in drafting guidelines on
the use of e-learning
approaches.
February 28, 2019
March 31, 2019
April 30, 2019
Policy Advisor and Senior
Technical Officer
Policy Advisor and Objective 2
Lead
Policy Advisor and Objective 2
Lead
Lack of a central custodian
for HR data and HRIS.
Work with the Objective 3 Lead to
develop a framework and guidelines
for the establishment of the HRIS.
• Review mandate of each agency
(possible custodians identified
include DOH, PRC, PSA)
• Organize meeting between
agencies to agree on custodian
May 31, 2019
Policy Advisor, Senior Technical
Officer, and Objective 3 Lead
Lack of policy on the PX Work with the OD Lead to develop a
policy framework and guidelines for
the PX approach.
• Review and analyze good
practices in the PX based on
case studies.
• Identify critical standards and
components of the PX
approach.
• Work with the Objective 3
Lead on drafting policy
guidelines for the PX.
March 30, 2019
April 31, 2019
June 30, 2019
Policy Advisor and Senior
Technical Officer & OD Lead
Policy Advisor and OD Lead
Policy Advisor and OD Lead
HRH2030/Philippines Y1Annual Report/21
4. Cross-Cutting Issues
4.1 Update on Gender
Arrangements have been made with the Chemonics head office and the Office of Health,
USAID/Philippines to institute gender training once requisite FP training has been completed.
4.2 Update on Sustainability and Self-Reliance
A cornerstone of HRH2030’s approach in the Philippines is to empower the DOH and engage local
partners, such as the HRH Network and CHED, to ensure that their skills and resources are sufficient
to effectively develop, deploy, train, and manage a fit-for-purpose and fit-for-practice health workforce.
HRH2030 will focus on building national stakeholder skills and knowledge so that they can assess,
develop, and implement effective workforce planning strategies without relying on donor support.
During Year 1, HRH2030/Philippines obtained commitment from the DOH that e-learning platforms
would be maintained and mandated by policies. Although HRH2030 engaged the DOH and subnational
partners during the first year, their ownership will be encouraged by increasing their involvement in the
development and rollout of HR subsystems at the SDNs. We envision that while the project focuses on
policy institutionalization and expanding coverage of selected provinces and SDNs from the HRH2030
project sites to other non-project target sites, regional units that have been strengthened will be
requested to implement similar activities in other provinces in the regions, with minimal support from
HRH2030/Philippines.
Our Year 1 activities were designed to lay the foundation for the lasting impact of the HRH
interventions. For example, our Year 1 work plan includes conducting an HLMA, which will help us
identify not only necessary immediate HRH improvements, but other opportunities to enact change
through activities that will continue beyond the life of the HRH2030 program. We also envision that
workforce planning and HRH data tools, such as the WISN and NHWA, will be institutionalized.
Last, HRH2030 will work with other USAID implementing partners for the continuance of the
implementation of key interventions (e.g., the WISN, HLMA, e-based learning systems, HRH
information systems) to contribute to improved outcomes.
4.3 Update on Environmental Compliance and Climate Risk Mitigation On May 31, 2018, the USAID/Philippines Environmental Officer noted that HRH2030/Philippines is not
required to formulate an Environmental Mitigation and Monitoring Plan or a Climate Risk Mitigation
plan, given the low risk actions in the work plan. However, if new activities are added, the HRH2030
team will work with the mission to ensure that these new activities are crafted with climate risk
management and environmental compliance in mind.
4.4 Update on Family Planning Compliance The activity is currently waiting for the mission to schedule an in-person facilitation for FP compliance
training. As of this writing, the mission has been in touch with the activity to initiate the process of
organizing the learning session. HRH2030 ensures that all staff members complete the online Family
Planning and Protecting Life in Global Health Assistance training courses.
HRH2030/Philippines Y1Annual Report/22
5. Collaboration, Learning and Adapting The following table summarizes the CLA activities during the period.
Key Learning Current and Planned
Application
Stakeholders
Involved
HRH interventions need to be delivered
in an integrated approach and recognize
the varying roles of stakeholders at
different levels of the health system.
Technical components need to develop
their own technical frameworks that are
aligned with the HRMD framework. This
can be a rallying point for sectoral action
to address health and non-health HR
issues.
Cross-cutting issues, such as
interoperability and inter-professional
integration, are also integration areas.
• Advocate for the adoption of
the HRMD framework by the
DOH and the HRH Network.
• Internally, the application of
the HRMD framework will
need to be translated to
component technical designs
or approaches. Areas of
integration will be discussed
during Year 2 HRH2030 work
planning.
DOH
CHED
PRC
CSC
Nursing and medical
societies; OWWA
Initial findings from the assessments
include demand generation issues for the
adoption of HR systems or products.
Examples are:
1. Low use of IST e-learning
modules
2. Non-compliance of reporting to
the HRIS by many non-health
agencies and even among the
national and local health
networks (NDHRIS only
contains 60% of the information
on hospital-based HR data)
• Develop a promotions/social
marketing plan for marketing
the adoption of e-based
learning modules already
certified by the DOH.
• Advocate for USG
implementing partners to use
the e-learning systems.
• Work for PRC accreditation
of e-learning modules; certify
modules as CPD compliant.
USG implementing
partners
Academia and
midwife/nurses/doctors
associations
Although there has been a positive
response and buy in for activities by
stakeholders, their continued
involvement will be critical in
undertaking post-assessment activities:
data analysis, planning, and implementing
action points, and monitoring and
evaluating progress.
• Present assessment findings
during the HRH Network
meetings/organized to identify
action points for each
organization and work
through the DOH to obtain
partners’ commitment.
• Discuss with the DOH the
adoption of a common HR set
of indicators.
HRH Network
DOH
Academia (for IST
modules)
Need to assist the HHRDB to establish
collaborative mechanisms in the DOH to
improve support from programs (FP, TB,
BLHD).
• Provide a venue for discussion
and agreement by decision-
makers.
• Involve key DOH officials and,
if feasible, work for the
DOH Executive
Committee, HHRDB,
FPP, NTP, BLHD
HRH2030/Philippines Y1Annual Report/23
Key Learning Current and Planned
Application
Stakeholders
Involved
establishment of a working
group in the DOH.
Presence of (1) HR initiatives of other
partners and donor initiatives; (2)
success stories on the ground; and (3)
evaluations (e.g., CMSS) where we can
build on/demonstrate effectiveness of
HR system improvements.
In the TB harmonization workshop in
May 2018 where two new USG
implementing partners have
interventions on patient satisfaction, and
development of e-learning modules are
also being explored.
• Document these initiatives,
synthesize elements of good
practice.
• Conduct harmonization
meetings with USG
implementing partners and
other partners.
WHO, Health Systems
Strengthening (HSS),
TB and FP projects of
USAID
Preparation of concept notes as a
collaboration instrument to elicit partner
feedback on (1) assessment designs; (2)
identification of strategic interventions;
and (3) documentation.
These can be further developed into
technical notes/implementation research
designs that will inform partners of the
effectiveness of designs and/or
approaches.
• Use concept notes to draw
consensus on
approaches/technical
frameworks from partners.
• Development of policy briefs
for decision-making
Objective leads
6. High-Level Planned Activities for Next Quarter, Including Upcoming
Events
During the first year, HRH2030 established a working relationship with the DOH and the
HRRDB and launched the joint mission with the WHO to provide technical assistance to the
DOH on the development of the NHWA and WISN and implementation of the HLMA that are
appropriate to the country’s situation. Collaboration with the HRRDB will continue throughout
the life of the activity, with the goal of institutionalizing workforce planning systems and tools
that are piloted at select SDNs. We will assist the HHRDB, including regions, to establish
technical working groups and the estimation of staffing requirements for key health cadres. The
design, data requirements, and initial report on the HLMA will be completed by the third
quarter of 2019, and the recommendations will be presented to the DOH and HRH Network.
HRH2030 will launch a higher capacity and more cost-effective e-learning portal and platform in
March 2019, and then will provide support during the first year. Specific high-level activities for
the next quarter include the consultations with top DOH officials on the development of an
HLMA roadmap for the country. In succeeding periods, upon the completion of the WISN
studies, the results of the analysis from the surveys will be presented to top management.
Launching activities will also be conducted sometime in April 2019 for the e-based learning
modules. Policy forums, organized to discuss HRH policies, will also be conducted as a series
of activities that will cover various HRH-related themes will be organized within the year.
HRH2030/Philippines Y1Annual Report/24
HRH2030/Philippines Y1Annual Report/25
7. Annexes
7.1 Success Stories, Pictures, etc.
As noted in the communications section of this report, content, including photos, was gathered
for success stories in Year 1 and stories will be published and disseminated in Year 2.